Closing the Asthma Gap for Minority and Poor Children

EPA scientists and their partners are working to better understand why asthma disproportionately affects minority and poor children.

Nearly 26 million Americans, including seven million children, are affected by asthma, a chronic respiratory disorder that causes airways in the lungs to swell and narrow, leading to wheezing, coughing, and shortness of breath. The annual economic cost of asthma, including direct medical costs from hospital stays and indirect costs such as lost school and work days, amounts to approximately $56 billion.

But when emergency room doors burst open for someone with an asthma attack, chances are the patient will be a poor, minority child.

According to the Centers for Disease Control and Prevention (CDC), minority children living in poor socioeconomic conditions are at greatest risk. For instance, 16% of African American children had asthma in 2010 compared to 8.2% of white children, and they are twice as likely to be hospitalized with an asthma attack and four times more likely to die than white children. The asthma rate among children living in poverty was 12.2% in 2010, compared to 8.2% among children living above the poverty line.

"Across America we see low-income and minority children and families at a disproportionately higher risk for asthma and respiratory illnesses. Air pollution and other challenges are having serious health effects, which compound economic challenges through medical bills and missed school and work days," said EPA Administrator Lisa P. Jackson. "As the mother of a child with asthma, I know what it means for our children to have clean and healthy air to breathe."

A major part of that effort is the work conducted by EPA scientists and their partners exploring environmental causes and triggers of asthma, including how socioeconomic factors contribute to childhood asthma. The overall goal is to illuminate the underlying factors of asthma to support work on prevention and intervention strategies.

What increases the risk of developing asthma? While part of the answer certainly lies with genetics, as more than half of all children with asthma also have close relatives with the illness, the environment also plays a key role. Air pollutants, allergens, mold, and other environmental agents trigger asthma attacks.

EPA researchers and their partners are leading the effort to develop new scientific methods, models, and data for assessing how such triggers increase the risk for asthma and asthma attacks. The impact of this research has already contributed to current regulatory standards for two priority air pollutants regulated under the National Ambient Air Quality Standards (NAAQS): ozone and particulate matter (PM). EPA's asthma research has also been factored into health assessments for diesel emissions.

The next step is to learn ways to better protect those most at risk.

"Now we're digging into the disparities side of the asthma problem," said Martha Carraway, MD, a researcher at EPA. "Kids with poorly controlled asthma are more likely to be treated in the emergency room than kids with controlled asthma. So for public health reasons we need to understand how environmental factors, including air pollution, affect asthma control in vulnerable populations."

To advance that work, EPA researchers and their partners took advantage of a 2008 lightning strike that occurred in Pocosin Lakes National Wildlife Refuge in North Carolina. The 40,000-acre (16,000-hectare), smoldering peat fire sparked by the lightning sent thick, billowing clouds of smoke wafting into the air.

In collaboration with scientists at the University of North Carolina Center for Environmental Medicine, Asthma, and Lung Biology, a team of EPA researchers led by David Diaz-Sanchez, PhD compared emergency room visits for asthma with air quality reports. Looking at the results geographically, they found that low income counties had significantly more visits than more affluent counties, even though air quality and exposure levels were the same.

"EPA studies suggest that children and others living in low-income counties could be less resilient to air pollution, possibly because of social factors such as inadequate nutrition. For example, if you're poor and you're not eating well, your asthma may be more severe," said Nsedu Obot Witherspoon, MPH, the Executive Director of the Children's Environmental Health Network, a national multi-disciplinary organization whose mission is to protect developing children from environmental health hazards and promote a healthier environment. "Of course, other factors may also be involved, such as whether kids take medications correctly and whether they have access to good medical care."

EPA's research on asthma disparities can help guide newer and better interventions for reducing exposure to asthma triggers and limiting the impacts of the ailment, helping to close the gap for minority and poor children and improving the health of children everywhere.

EPA's "Science Matters" will feature Safe and Sustainable Communities Research, including the links between income disparities and environmental health and justice issues in the a future issue. Subscribe now at: http://bit.ly/SOT6a5.

In May 2012, the President's Task Force on Environmental Health Risks and Safety Risks to Children released the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities. The goal of the plan is to build on the strength of past and existing federal programs while developing collaborative strategies to plug the knowledge gap with resources that already exist.

Low-income and minority asthma sufferers face challenges such as limited access to quality medical care, low levels of health literacy, and inability to afford medication. Additionally, they face higher levels of environmental exposure to allergens and pollutants that exacerbate asthma and lack community level activities to reduce outdoor air pollution.

The action plan, in which EPA is a major partner, focuses on the following four strategies:

Reduce barriers to the implementation of guidelines-based asthma management

Enhance capacity to deliver integrated, comprehensive asthma care to children in communities with racial and ethnic asthma disparities

Improve capacity to identify the children most impacted by asthma disparities

Accelerate efforts to identify and test interventions that may prevent the onset of asthma among ethnic and racial minority children

Science to Support National Ambient Air Quality Standards

Protecting the health of children and other vulnerable life stages and populations is a key consideration in setting the National Ambient Air Quality Standards (NAAQS), which set pollutant limits to protect human health and the environment.

EPA scientists support the development of NAAQS in many ways. Two specific examples include reviewing the body of research about pollutants through Integrated Science Assessments (ISAs) and making children’s activity data easily available to decision makers through the Consolidated Human Activity Database (CHAD):

ISAs: Two pollutants of particular concern for asthma are particulate matter (PM) and ozone. To provide the scientific basis for the NAAQS for PM, EPA scientists assessed the latest research on the effects PM has on public health and welfare. The findings were published in the Integrated Science Assessment (ISA) for Particulate Matter (available at http://bit.ly/PM_ISA). EPA is also developing an ozone ISA to ensure the NAAQS for ozone is supported by the best up-to-date science.

CHAD: EPA research also supports the NAAQS through theConsolidated Human Activity Database (CHAD). CHAD provides information on the activities of children and adults. Using this information, scientists and engineers can simulate children’s activities and breathing rates to see how much of a pollutant a child inhales during daily activities. This information ensures that the NAAQS protect children as well as adults.

Based on their research results, health scientists at Columbia University’s Children’s Environmental Health Center helped implement an integrated pest management (IPM) plan for controlling rodents and cockroaches, which carry allergens that can trigger asthma attacks.

“The EPA/NIEHS funding helped us to carry out an exciting intervention that reduces pests that carry asthma allergens while at the same time reducing the use of toxic pesticides,” said the Center’s director, Frederica Perera, DrPH, a professor of environmental health sciences at Columbia University. “And these interventions were carried out in low-income populations at most risk from asthma.”